BOOK REVIEWS

In this book Alasdair MacIntyre confronts two rival accounts of practical reasoning. One based on the satisfaction of individual desires and another based on the achievement of human flourishing. MacIntyre sets out to vindicate the latter as superior. The theory of practical reasoning which gives emphasis to the satisfaction of desires descends from the work of David Hume and takes modern form in the meta-ethical doctrine of expressivism. According to expressivism ethical judgements are subjective expressions of emotion, attitude or commitment; not the sorts of things that can be true or false. For an expressivist, to say that murder is wrong is ultimately to say that he disapproves or feels outrage at murder. The theory of flourishing that MacIntyre defends in opposition to expressivism is a form of Aristotelian teleology. According to teleology the good is what objectively fulfills our natures as rational animals. For a teleologically oriented thinker, to say that murder is wrong is not to express an emotion, but rather to state that murder is detrimental to human flourishing. MacIntyre claims that the choice between expressivism and teleology is the most fundamental moral polemic of modern times.

The Introduction has the following very important addition. " 12. It may be objected, indeed, against the foregoing observations, that although mistakes may have been sometimes com-r mittcd, by not distinguishing the sequel? of Syphilis, or the noxious effects of Mercury, from the specific action of the venereal virus, yet, many of the testimonies adduced in favour of these peculiar modes of cure, tend to demonstrate their efficacy in cases where no Mercury had been previously employed ; and also, that the primary, as well as the secondary, symptoms of Lues Venerea have been cured by them. " In proceeding to obviate what has been now alleged, I must, in the first place, express a doubt of the fact ; not, indeed, whether sores 011 the penis, or tumours in the groin, have been cured without the aid of Mercury ; but whether these symptoms, thus permanently removed, were in reality Venereal. What was the true nature of those complaints cannot now be ascertained : but if it be allowed, that appearances 011 the organs of generation, very much resembling the primary symptoms of Lues Venerea, do frequently take place from other causes; and if it be assumed as another fact, that Mercury is the only medicine yet known, that cures the venereal disease with certainty, we shall be assisted in forming a probable and not an incorrect opinion on the question before us. Every surgeon, who is engaged in much practice, must be frequently consulted on the nature of complaints, resembling the Chancre' and the Bubo, which are not Venereal ; and that which is not an unusual occurrence now, no doubt, presented itself as commonly in former times: for I think it will be difficult to assign a satisfactory reason, why an immunity from these morbid appearances should have been conferred 011 those who lived a century or two ago, and be refused to their posterity in the present day. The conclusion to be deduced from these remarks is obvious.
Without imputing prejudice, perverseness, mala Jides, or any other unworthy motive, to those writers who have published the narratives referred to, it will be quite sufficient to urge the imperfection of their history of Lues Venerea, as* an apology for the incorrectness of their representations. " It can scarcely be necessary to remind the reader, that the organs of generation, in both sexes, were frequently infested with very troublesome local diseases many ages before Syphilis was known in the world ; and it cannot b<? presumed, with any colour of probability, that they were all finally extinguished 011 the appearance of that malady. Many of the diseases of these parts described by ancient writers, do certainly still occur ; and I believe myself warranted to suspect, that'new forms of disease not unfrequently arise, which are succeeded by a regular series of symptoms, nearly resembling the progress of Lues Venerea. An acquaintance with these and similar sources of error, must necessarily inspire a considerable degree of distrust, when we are presented with narratives, the leading circumstanccs of which are directly directly at variance with the best verified data in the history of Syphilis : nor will it imply either a want of deference, or of candour, to suppose the writer defective in the knowledge of his subject, rather than impute inconstancy and discordance to the order and method of nature.
" The spurious appearances to which I allude, are not, therefore, always to be regarded as the Sequel? of Syphilis, or the efiects of Mercury; since a distempered state of body, equal to the production of these morbid phenomena, may be the offspring of other causes, or a consequence of diseases, which have no affinity with Lues Venerea. I have not yet attained to that complete and satisfactory knowledge of the Cachexia Syphiloidea, which would authorize me to obtrude a publication on the subject; but the experience I have already had in the treatment of that multiform, disease, has taught me, that it may appear under the following different circumstances. " 1.
Where the Syphilitic virus has lately existed in the constitution, and the patient has employed the accustomed course of Mercury. " 2.
Where the patient has been repeatedly diseased with Syphilis, and has used several courses of Mcrcury. Where a great length of time, from three to twelve, and sometimes twenty years, has elapsed since the patient has been exposed to the agency of the disease, and its remedy. After the Gonorrhoea, where small quantities of Mercury have been used. " 5. Where no venereal complaints, general nor local, have preceded the appearance of the Cachexia Syphiloidea ; and where the patient has never been exposed to the hazard of contracting that disease, nor has laboured under complaints requiring the aid of Mercury.
" The three sources of error which I have now indicated ; the sequelae of Lues Venerea, the direct effects of Mercury, and the Cachexia Syphiloidea, may assist the student in solving many of the difficulties which will ^obtrude themselves, while he is studying the history and treatment of the Venereal disease. They may seem, at the same time, to acquit those of an unreasonable scepticism, who peruse the narratives of extraordinary cases, and marvellous cures, with suspicion and distrust. How much, or how little, our forefathers knew concerning these matters, would be an inquiry perhaps as unprofitable, as it would be unsatisfactory : since nothing could be more easy to an ingenious and well informed .mind, than to adduce passages from early authors, in justification of any thing he may please to assert, and to infuse a sense and a meaning into detached expressions, far beyond what the writers themselves either taught, or conceived. Allowing every reasonable degree of merit to those original writers on Syphilis, who flourished before the 18th century, and much merit is undoubtedly due to uiany of them, yet it must be obvious to those C No. 98. ) C c who 578 Mr. Pearson, on the Cure of Lues Venerea.
who will take the trouble of examining their works, that their know* ledge of some of the subjects to which I have now adverted, wai too inadequate to command an-implicit reliance either on their deductions, or their representations.'' On this passage it is impossible not to make one remark. When a young practitioner starts his doubts, we are charmed with his modesty. But from one, who has appeared before the public nearly thirty years as an hospital surgeon,' a public lecturer, and an author, we expect some information mixed with doubts. When we are told of varieties arising from so many causes and so complicated, of symptoms so easily confounded, yet requiring a mode of treatment directly opposite,' and that from so experienced a guide We can at present expect no other assistance than the few hints contained in live short paragraphs?How dreary, how discouraging, must be the prospects of the student, or young practitioner ! Must they not almost end in despair; when, on a re-ex* amination of the assistance here held otit, cury : if so, Mr. Pearson's remarks are not only very proper but highly necessary.
The 13th chapter, on Eczema mercuriale, is altogether an addition to the present edition. It contains a much better account of what the author calls the mercurial rash, or, as it is called by some others, the Lepra mercurialis, than is to be met with in any other work.
Thesse, we believe, are the principal, if not the only alterations in the present edition. They are certainly sufficient to increase the value of a peformance, which was before well received by, and highly deserving the attention of, the medical world.
A Treatise on the Varieties and Consequences of Ophthalmia ; with a Preliminary Inquiry into its Contagious Nature. By Arthur Edmonston, M. I). Fellow of the Royal College of Surgeons, and Honorary Member of the Royal Physical Society of Edinburgh. Edinburgh, 8vo. 1806".
In the year, 1802, Dr. Edmonston published a small Tract on the same subject, an account of which, the reader will find in page 1S5, vol. viii. of our Journal. The present work is very much enlarged. The" author gives us an historical detail of the opinions of the various writers on the contagious nature of Ophthalmia, from Galen to the present times; after which, he goes at large into all the varieties of the disease ; distinguishing their stages, causes, consequences, and methods of cure. Of these, wo shall take notice in their order. The " Preliminary Inquiry into the contagious nature of Ophthalmia," consists, first, of the historical sketch of the opinions entertained concerning the contagious nature of this disease, 1U this, the author shows, that till the late Egyptian Expedition,, nu clear reasoning on the contagious nature of this disease can be discovered, excepting in the Inaugural Dissertation of Dr. James Armstrong, de tuenda nautarium sanitate ; printed at Edinburgh, Dr. Edmonston, on Ophthalmia .nautis qui semper in hac nave fuisscnt, inane querebantur, sess proxima nocte acuto dolere in anteriore parte capitis correptos fuisse, et eodem tempore, molesto oculorum, haud secus ac si iis pulvis inspersus fuisset, sensu aflectos. Postero mane, alii complures sese priore nocte correptos eodem modo et iisdem malis fuisse aiebant et septimi mane diei ex quo tempore primi duo affecri fuerant, viginti duo ad usitata munera pracstanda ineptos hicce morbus jam reddiderat. Nonnulli propter dolorem capitis acutum, lecto affigebantur neque caput ex pulvino levare poterant, et inflammatio eo invaluerat, ut oculorum color carnem crudam quam maxime referret. Morbo tarn cito in dies ingravescente, ne latius pateret, prcefecto navis aigrotos omni cum sanis commercio interdicere necessarium visum est. Qua re facta, contagio non amplius viginti quinque affecit, et post quinfjue circiter hebdomadas quam primum, in navem advecta fuisset omnino evanuit." Dr. E. remarks, that the only circumstances tending to weaken the support, given by this extract, to the contagious nature of ophthalmia, are the circumscribed scene of its operation, and the speedy and total destruction of this, supposed, contagious principle. In both these respects, it is said to differ from other instances of a similar natnre, hereafter to be stated.
Though we shall again meet our author on this subject, we cannot help stopping by the way to remark, that if the arrival of certain individuals from an infected ship, the consequent disease in a part of the ciew, and the security of the remainder, by an immediate seclusion of the diseased from the sound, are not sufficient proofs of contagion ; or if they do not confirm the reasoning drawn from " instances which are hereafter to be stated," we cannot help wishing, that our author had succinctly defined what he means by contagion. It is not enough, that, in the succeeding chapter, after giving us the history of the ophthalmia, as it appeared in the 2d Regiment of Argyleshire Fencibles, he enters regularly on the analogy between that and contagious diseases in general.
By the history, it appears, that the above regiment embarked in a healthy condition at Gibraltar, on board the Delft, which had brought troops from Egypt labouring under fever and ophthalmia-She was, however, well fumigated ; the bedding was new, but the hammocks were the same as those occupied by the former crew.
A lieutenant of the Delft, who had lost an eye in Egypt, and at that time laboured under the disease, was the only person on board who could not be considered in perfect health.
During the voyage from Gibraltar to England, one case of ophthalmia occurred twelve days after embarkation, and another four days after the first. A few slight cases of fever also occurred.
The ship was crowded. The regiment remained ten days in Hilsea Barracks; and during that period twenty-one new cases occurred. The regiment was marched to Colchester, a distance of > one otic hundred anil twenty miles, in eleven days. During the march four new cases occurred, all of them mild, and those before afflicted recovered.
Three days after arriving at Colchester the disease recurred with increased violence, and the invasion seemed very quickly to follow exposure to the cause. Seventy-five were infected when the regiment removed to Norman Cross. On the first and second day of the march the invalids complained of being worse ; but during the remainder of the journey all of them mended. Twelve cases occurred on the road, all of which were slight. The Middlesex militia were at Colchester, and seemed to have been infected by the Argylcshire. The officers of the latter escaped till the regiment was marched to Scotland. The Author gives the following account of the circumstances to which he attributes his own seizure. " Medical men, from their hourly communication with every variety of disease, seem to acquire a kind of incapability of being affected by any; but if they intermit their professional labours for a time, they are equally liable with others. I happened to be absent from the regiment a few days when the disease was at its height. On my return, I was anxious to see the changes which the different cases had undergone, and was, perhaps, too minute in my examinations. That very same day I felt the sensation of a foreign body in the eye, the tunica adnata was inflamed, and a discharge of a watery fluid took place. But the assistant surgeon, who remained with the regiment during the whole of the time, escaped entirely/' Such is the history of this disease, of the appearance of which, Dr. E. remarks, that it had, in many instances, all the malignity of the Egyptian Ophthalmia. That it proved fatal to vision in no instance, he ascribes to early and repeated scarifications. A few paragraphs follow, in which, the author finds no difficulty in showing, that the common causes of ophthalmia are insufficient to account for the progress of the above disease : After which, he attempts an " Analogy between the preceding ophthalmia, and contagious diseases in general.'' " Some contagions," says our author, " such as lues venerea, require absolute contact to produce the effect, while in others, as small pox and measles, it is sufficient to breathe the atmosphere of the same room with the person under disease. But even in the most malignant cases, the sphere of action does not extend beyond a few feet from the source.

"
If left to nature, they exhibit certain regular periods of rise and decline, and in these instances they seem to follow unequal periods. But if they are interrupted by art, these catenations of motions are broken, new associations are formed, and these changes cannot therefore be ascertained with sufficient accuracy. " Contagion, like every other material substance, is susceptible of partial accumulation and diminution, and in general pro-C c 3 duces.
duces its cffccts according to the degree of concentration in which it exists. Every circumstance which prevents its free diffusion in the atmosphere, such as the crowded state of ships and jails, favours its accumulation and aids its operation. "? Jn most cases it seems necessary, iri order to produce its full effects, that the body should be predisposed by debilitating powers, or, in other words, that causes which tend to change the state of its irritability had operated, although at times it extends itself under the most opposite circumstances.
" These arc a few of the leading laws of all contagious diseases ; and the Ophthalmia which occurred iR the second regiment of Argyleshire Fencibles, exhibits, in its origin and progress, a striking coincidence with them.
" Thus, a certain period elapsed before it made its appearance, and it occurred chiefly among the soldiers, whose confined situation, and the impure atmosphere which they breathed, materially affected the irritability of their systems, rendering them more easily affected by any noxious power; but when its energy became increased, it extended itself in every direction.
" Sleeping in the same room, or approaching near to the eye of a person labouring under the disease, was sufficient to produce it in another person. In this way almost all contagions operate. " The evening exacerbation and morning remission partake of the general nature of febrile disease; and the head-ach, restlessness, white tongue, and irregularity in the state of the circulation, are proofs thaj, it existed. The third day was usually the period of change. Contagious diseases follow unequal periods.
But in this case, as recourse was Lad early to medical assistance, the different gradations became less distinctly observable. " The march from Portsmouth to Colchester, in some measure arrested, although it could not destroy, the influence of the cause producing the Ophthalmia. Variety of scenery, and changes of situation, produce similar effects upon the hooping cough, smallpox, and other contagious disorders. " The march to Norman Cross had a similar effect, but as the disease had existed for a longer period, and individual cases were becoming worse, exposure to exciting causes naturally aggravated the symptoms. The same takes place, and must necessarily do so, in every disease where particular organs are chiefly affectf d.
As the authoi considers these to be " the few leading laws of all contagious diseases," we might suppose, he intends we should understard, that in these few, all such diseases agree. But in the first paragraph he has marked an essential difference. This is, however, of less consequence than he seems to make it, because contact, whether by the diffusion of matter in the air,' or by two palpable substances, is stili contact. But where is the analogy between the venereal disease, and one which if left to nature, has its periods of rise and decline ? or what interruption of art can break -Dr. Edmonston, on Ophthalmia. sss break the catenation of motions, or form new associations in small-pox or measles, so as to prevent our " ascertaining the changes with sufficient accuracy r" " Again, what is the partial accumulation and diminution, according to the degree of concentration, that alters the effects of small-pox and measles ? That the crowded state of ships and jails Professor Scarpa, and others, who have recently come before rist we would gladly have offered it to our readers. We mean not to say, that Dr. Edmonston has copied altogether from that useful work, any thing more than the arrangement; but where he differs from the Professor, our judgment has always been in favour of the latter. We shall not be expected, after this, to enter largely on this part of the work; but to satisfy our readers that we are not actuated by partiality, or disposed to misrepresent, *ve shall confine our remarks to a single Section, least connected with the general subject.
Symptomatic Ophthalmia is thus introduced. " Although various diseases give a predisposition to Ophthalmia, yet there are only two which can be said to modify its symptoms, and on many occasions to determine its duration.
These are scrophula and lues venerea." From such an introduction our readers will expect equal obscurity to continue throughout; and they will not be disappointed. Scrophula is a word of such general use, and so rarely defined, that, in our opinion, it is no better in the author's hands, than lentor of fltiids, (which he begins with condemning) in the hands of his predecessors. After a few words on the scrophulous u Diathesis, or temperament," which is said to be marked by a general flacidity and mobility of fibre" (a most perspicuous definitiun!) we have an account of the manner in which Ophthalmia is modified by such a predisposition. The description might be much better referred to Professor Scarpas's chronic inflammation. But there is something peculiarly loose in the introductory part of the Venereal Ophthalmia; " like scrophula, says our author, the syphilitic ?virus, when diffused through the system, frequently affects the eyes, and induces a particular species of Ophthalmia/' By this are we to understand, that Scrophula is a virus, which we were just nowtold was a diathesis? The description which follows is principally from Mr. Bell, including one symptom, which he remarks " has seldom been observed, and which is apt to be mistaken for an incipient fistula lachrymalis." But what principally engages our author's attention, is the Ophthalmia which arises from a suppressed gonorrhoea. After considering the various opinions on the subject, it must be admitted, that he falls into the most probable, viz. that if the Ophthalmia arises immediately on the cessation of gonorrhoea, it should be ascribed to sympathy, and not to a metastasis of matter. A metastasis of violent inflammation is by no means uncommon, but our experiences does not justify the occurrence of such an event from the urethra, in virulent gonorrhoea, to any other part than the testicle; and we are glad to be supported in this opinion by such men as Mr. Ware and Mr. Pearson, each of whom has as large opportunities of deciding such a question, as the metropolis can afford. Fortunately, however, the question is oot very important, for if only the inflammation is transferred without without the virus, the disease must be treated according to the symptoms which appear, without regarding the cause. An Essay on Ophthalmia ; containing ( The progress of this disease is traced with some accuracy; but wo very much regret that " delicacy," which will not permit the author to explain the causes of so sudden an increase in the numbers affected, which is stated to have been from sixteen to seventy in one month.
The author considers, as the most alarming appcarance, a violent tumefaction of the upper eye-lid, which is discoloured by a blueish tinge, accompanied with fever and shooting pains. The eye is closed, in consequence of which the increased secretion, if not occasionally dislodged, will ulcerate through the cornea, suffer Observations on the Humulus Lupulus of Linn arts ; with an Account of its Use in Gout,, and other Diseases: with Cases and Conmuftications. By A. Fiieake, Apothecary, Tottenham Court Road. Second Edition, 8vo. 1807.
We have already taken notice of the first edition of this Pamphlet, which, as the writer remarks, was circulated, principally, among the faculty, that the value of the remedy might be with more certainty estimated. 'I he trial has answered every expectation the author could wish. Four Communications are annexed, from four Fellows of the London College. Drs. Latham and Mayo, authorize Mr. Freaketo use their names; and Drs. Stone and Maton, add their signatures to Letters confirming the value of the remedy.
Dr. Stone does not indeed consider the hop in a much higher view, than as an useful variety with the other bitters; which, however, he conceives, it may supersede with advantage, not only on account of its more agreeable taste, but for its aperient qualities. Dr, Maton writes much more at large on the subject; after whose letter we have the following " Concluding Observations.
Ci I have now, for nearly six years past, administered the Lupulus in a variety of diseases, and I can with confidence assert that it is a very valuable medicine. I have not preserved an account of all the trials 1 have made of it, but I think I should be correct in asserting, that it has afforded relief in more than one half of the cases in which I have given it. I do not recollect a single instance in which I have had occasion to regret the employment of it; for, although a slight giddiness in the head has occasionally been produced, its duration was always very short. Dr. De Roche seems apprehensive that the saturated tincture may occasion diarrheea and pains in the bowels. 1 have not observed either these or any other unpleasant effects from it, nor has its administration prevented the use of other medicines as auxiliaries." Practical Observations on Urinary Gravel and Stone; on Diseases . of the Bladder and Prostate Gland; and on Strictures of the Urethra. By Henry Johnson, Fellow of the Royal College of Surgeons, at Edinburgh. Edinburgh, 8vo. 1806". It is not often that we meet with a book so completely unexceptionable as the present, and, we are obliged to add, from which we have learned so little. It is certainly a compendium of most that has been written on the subjects mentioned in th?-title page; nor is the author backward int>ffering his own opinions. But the latter are too often trite, as well as modest, and, in a few instances, sufficient credit is not given to the authors quoted. The latter, is, however, rarely the case. We shall only mention Mr.
Whateley's improvement in substituing kali purum for lunar caustic, stic, in the treatment-of strictures in the urethra The author does not seem aware, that the principal advantage proposed by the kali pururn, is, that by its'property of combining and forming soap with animal matter, a more complete solution of the stricture is procured, and th e necessity afterwards of casting off a slough is avoided. It is not our intention to enter into the inquiry, which mode of operating may be the best, but only of showing, that Mr. Johnson has not sufficiently explained the comparative properties of the two. ; *